直肠神经内分泌肿瘤G1内镜及病理学特征分析

目的探讨直肠神经内分泌肿瘤(NEN)G1的内镜和病理学特征。方法回顾性分析2007年1月-2012年12月行内镜活检并参考2010年WHO消化系统肿瘤分类标准病理诊断为NEN G1 18例患者临床资料,结合内镜观察结果及显微镜下组织学形态变化进行综合分析,免疫组化方法检测细胞广谱角蛋白(AE1/AE3)、细胞角蛋白(CK8/18)、嗜铬粒素A(CgA)、突触素(Syn)、神经元特异性烯醇化酶(NSE)、核抗原(Ki-67)表达情况。结果NEN G1在内镜下多为黏膜隆起性肿物,活动度尚可,质地偏硬。显微镜下肿瘤细胞排列成片状、巢状、条带状等结构;细胞较小,形态一致,核深染,无或很少有核分裂相。AE1/AE3、CK8/18、CgA、Syn及NSE的阳性率分别为100.0%、88.9%、83.3%、77.8%及55.6%,Ki-67阳性率均≤2%。结论 NEN G1缺乏特异性临床表现,通常体积较小,内镜观察不易明确诊断,AE1/AE3、CK8/18、CgA、Syn等的免疫组化检测对于辅助病理诊断尤为重要。

Endoscopic and pathologic features of neuroendocrine neoplasm G1 in the rectum

Objective To investigate the endoscope and pathology characteristics of rectal neuroendocrine neoplasm （NEN） G.Methods From January 2007 to December 2012, retrospective analyzed the clinical data of 18 cases with NEN in G1 which were underwent endoscopic biopsy and diagnosed according to the 2010 WHO classification of tumors of the diges-tive system of standard pathology.Combined with endoscopic observation and comprehensive analysis of tissue under a micro -scope for morphological change , immunohistochemical method were used to detect the cell cytokeratins （AE1/AE3）, cytoke-ratin （CK8/18）, chromogranin A （CgA）, synaptophysin （Syn）, neuron specific enolase （NSE）, nuclear antigen （Ki-67） expression.Results NEN G1 under endoscopic were mostly submucosal tumors , can be moved with hard texture.The tumor cells under the microscope arranged in a sheet , nests, banded structure;small cells,consistent shape,hyperchromatic nuclei, no or few mitoti.The positive rate of AE1/AE3, CK8/18, CgA, Syn and NSE were 10.0%, 8.9%, 8.3%, 7.8%and 5.6%, Ki-67 positive rate is less than or equal to 2.Conclusion NEN G1 lack of specific clinical manifestations , they are usually smaller , endoscopic observation is not easy to confirm the diagnosis , immunohistochemical detection of AE 1/AE3, CK8/18, CgA, Syn is very important for the pathological diagnosis.